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On this morning, they were willing to suffer a little bit longer, if it meant some relief from their pain at the sprawling clinic rising here.

Founded in 1985, Remote Area Medical — known as RAM — is an all-volunteer organization that provides free health care to some of the most remote and medically underserved areas in the United States and the world. It offers a portfolio of health care services, including dental care, and all its events are supported through donations or partnerships with other charitable organizations.

The care was free for the 2,292 patients seen over the course of three days. The medical equivalent of winning the lottery in a region where health care is often a gamble and dental care is often out of reach. This time, few were turned away.

“It doesn’t matter where it is in the United States — it can be California or it can be here — 65 percent of the patients that walk through the door are for dental care,” RAM founder Stan Brock said during an interview with POLITICO. “And about the same percentage are here for vision and eyeglasses. In other words, they need both.”

But both they can’t have, at least not during the same three-day event now in its 14th year in Wise County. They must pick, and about half, more than 1,000, elect for dental care. In the future, some may have many of their health care needs taken care of under the new health law — although some could still be left out if they live in states that aren’t choosing to expand Medicaid to low-income adults.

But conversations with several of the waiting patients here indicated they didn’t know too much about the president’s health law, the Affordable Care Act, or what it might mean for them and their families. But for those here with toothaches, it may not make much of a difference. The new health law may cover a lot of services, but most adult dental care won’t be part of it.

As the gates opened precisely at 5:30 a.m., the crowd filtered in according to pre-assigned numbers. The grounds cultivated for vegetables and livestock were transformed into a military-style surgical hospital, complete with a small army of surgeons, physicians and volunteers. Open-sided tents protected dozens of dental chairs placed neatly in rows. PVC pipe snaking along the edge of tents and tarp-lined shelter carried the mixed remains of cleanser, spit and blood. The smell of antiseptic — not farm — filled the morning air. Nervous student volunteers insist it is a sterile enough environment.

The waiting patients, many clearly in pain, did not seem to notice the austere conditions. By the end of the three days, 3,926 adult teeth would be extracted, and an additional 70 from children. Some 1,635 cavities would be filled. As patients walked away, relieved of pain, their smiles pierced through mouths crammed with bloodstained gauze.

“All these years later, people are still losing teeth in these mountains,” said Carole Pratt, a volunteer dentist for Mission of Mercy, which partners with RAM here at Wise.

“I would have loved to have seen the Affordable Care Act include dentistry for adults, but it didn’t,” said Pratt. And state cutbacks mean public health dentists are vanishing across the country. Pratt said that 70 dental chairs are going unused not far from Wise County Fairgrounds because public dentists are not available to provide needed care.

“Charity is not a solution long term,” said American Dental Association President Robert Faiella, who was volunteering at the fairgrounds. But charity is what many dentists offer, pro bono care without state reimbursement, he said. “Most dentists do it silently because they feel the need to do the right thing,” Faiella said.